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Advanced Neurology Sleep and lifestyle factors in young adults with childhood TBI

consecutive admissions to the neurosurgical ward of The current age, employment status, level of education, and
RCH between 1993 and 1997. Inclusion criteria in the injury severity.
original study were : (i) Age at injury between 0 and
[32]
12 years; (ii) documented evidence of TBI, including 2.4.2. Lifestyle factors
a period of altered consciousness at the time of injury; General lifestyle factors were evaluated through
and (3) English speaking. Exclusion criteria were: (i) administration of a study-designed questionnaire. Mean
Penetrating head injury; (i) head injury resulting from responses from these questions were assessed over a 14-day
abuse; (iii) history of previous head injury; and (iv) period (during which the actigraphy data were collected)
evidence of pre-existing physical, neurological, psychiatric to assess the following lifestyle factors:
or developmental disorder. No additional inclusion/ (i). Parenting status (Do you have children? Yes/No)
exclusion criteria were applied in this 20-year follow-up (ii). Substance use: Frequency of alcohol and cigarette
due to the longitudinal nature of this study and attrition. intake (During the past 2 months which of these
The study originally included 172 children with TBI and substances have you used?).
35 typically developing controls (TDC), identified through (iii). Screen time: Duration (Number of hours spent using
the families of the injured children and local schools, and electronic device today, scored on a scale of 1 – 12 h),
matched to the TBI group on age, sex, and socioeconomic daytime naps (total time I spent napping during the day
status (SES). Reasons for dropouts in previous follow-ups today, in hours).
were unwillingness to continue the study (9); deceased (iv). Caffeine use (How many caffeinated drinks did you
(2). Of the 196 invited for the 20-year follow-up, 67 take today, e.g., coke, coffee, tea, energy drink. Options:
participated and the reasons provided for not participating 0, 1, 2, 3, 4, more than 4).
were: time constraints (1), loss of interest (3), and death (v). Medication use: Current or previous use of
(2); declined participation (13); declined participation after antidepressants, stimulants, and pain medications
consenting (6); could not be contacted even with updated was assessed with this question in the study-designed
state electoral registration information (102); and did not questionnaire (Have you, or are you currently taking
complete some of the questionnaires presented in this any of these medications (e.g., antidepressants,
study (2). The questionnaire data presented here are based stimulants)? Yes/No).
on 67 participants (mild = 14; moderate = 27; severe = 13;
and TDC = 13), while the actigraphy data are based on 58 2.4.3. Chronotype
participants (mild = 12; moderate = 22; severe = 11; and Chronotype was assessed with the Morningness and
TDC = 13) due to technical problems with this measure. Eveningness Questionnaire (MEQ), which assesses
TBI severity classification was based on the following: chronotype using 19 questions [34] . The MEQ total
(i) Mild TBI (n = 44): Glasgow coma scale (GCS) score score, obtained as a sum of responses from all items
on admission of 13 – 15, post-traumatic amnesia (PTA) ranges from 16 to 86. Scores of 16 – 41, 42 – 58, and
<24 h, and no abnormality on computed tomography (CT) 59 – 86 were used to differentiate between participants
or magnetic resonance imaging (MRI) scan; (ii) moderate with eveningness, intermediate, and morningness
TBI (n = 81): GCS on admission = 9 – 12, PTA 1 – 7 days, chronotypes, respectively.
and/or abnormalities on CT or MRI scan; and (iii) severe
TBI (n = 47): GCS = 3 – 8 at the time of admission, PTA 2.4.4. Sleep outcomes
> 7 days, and abnormalities on CT or MRI scan. Subjective sleep quality was assessed with the Pittsburgh
Sleep Quality Index (PSQI), which examines sleep quality
2.3. Procedure over the past month using five descriptive questions and 14
A detailed account of the recruitment procedure and multiple-choice questions. The PSQI produces a total score
questionnaire administration methods has been reported of 0 – 21, and scores above 5 indicated poor subjective
previously [20,33] . Briefly, all participants provided written sleep quality in this study .
[35]
consent and completed all questionnaires either in hardcopies Objective sleep efficiency, defined as the ratio of
(sent through post) or online through REDCap, and all total time spent asleep over total time spent in bed, was
actigraphy watches were sent to participants through post.
assessed using Actiwatch 2 (Phillips-Respironics). The
2.4. Measures actigraphy method estimates sleep and wake activity based
on movement and correlates with key parameters on the
2.4.1. Demographic and injury-related information polysomnography . We recorded actigraphy data and
[36]
A demographic questionnaire and medical records of Night Sleep Diaries (used to validate actigraphy data) over
participants provided information on sex, age at injury, 14 consecutive days. Consistent with previous actigraphy

Volume 2 Issue 3 (2023) 3 https://doi.org/10.36922/an.0876